Rybrevant (Amivantamab-Vmjw) for Lung Cancer

Overview
Rybrevant is approved by the U.S. Food and Drug Administration (FDA) for the treatment of lung cancer. It is specifically indicated for adults with locally advanced or metastatic non-small cell lung cancer (NSCLC) with EGFR exon 20 insertion mutations, as identified by an FDA-approved test. This indication covers its use both as a single agent and in combination with the chemotherapy drugs carboplatin and pemetrexed for first-line treatment.

Rybrevant has also been approved in combination with lazertinib for the first-line treatment of adults with locally advanced or metastatic NSCLC with EGFR exon 19 deletions or exon 21 L858R substitution mutations, as detected by an FDA-approved test. Lazertinib is an EGFR tyrosine kinase inhibitor (TKI) that works by blocking the EGFR protein, which can help slow or stop the growth of cancer cells that have certain EGFR mutations.

Rybrevant is also known by its drug name, amivantamab-vmjw.

Rybrevant belongs to the category of antineoplastic agents, specifically as a bispecific antibody targeting both the EGF and MET receptors. This dual targeting is thought to interrupt the growth signaling pathways that are overactive in certain types of lung cancers, thereby inhibiting tumor growth and spread.

How do I take it?
Rybrevant is administered through an intravenous infusion, with the dosage based on the recipient’s baseline body weight. The drug is initially given weekly for four weeks, with the first dose split between two days in the first week. 

From there, treatment changes depending on whether it’s used as a stand-alone therapy or in combination with others:

• When administered as a single agent, the treatment generally shifts to every two weeks starting at Week 5.
• For those receiving Rybrevant in combination with chemotherapy (carboplatin and pemetrexed), the treatment usually continues every three weeks starting at Week 7.
• When Rybrevant is administered in combination with lazertinib, the treatment is generally given weekly for five weeks, with the initial dose split between two days in the first week, and then every two weeks starting at Week 7. Additionally, when using this combination, anticoagulant prophylaxis is recommended for the first four months to prevent venous thromboembolic (VTE) events.

Premedications are sometimes recommended to manage potential side effects. This medication should be taken exactly as prescribed by a health care provider.

Side effects
Common side effects of Rybrevant as a stand-alone therapy rash, infusion-related reactions, paronychia (nail inflammation), musculoskeletal pain, dyspnea (shortness of breath), nausea, fatigue, edema (swelling due to trapped fluid), stomatitis (inflammation or soreness of the mouth), cough, constipation, and vomiting. The most common Grade 3 or 4 laboratory abnormalities include decreased lymphocytes, decreased albumin, decreased phosphate, decreased potassium, increased alkaline phosphatase, increased glucose, increased gamma-glutamyl transferase, and decreased sodium.

When used in combination with carboplatin and pemetrexed, additional common side effects may include decreased appetite, diarrhea, and COVID-19.

When used in combination with lazertinib, additional common side effects may include VTEs, paresthesia, diarrhea, dry skin, decreased appetite, and COVID-19. Additional common Grade 3 or 4 laboratory abnormalities include increased liver enzymes.

Rare but serious side effects of Rybrevant as a stand-alone therapy may include infusion-related reactions; interstitial lung disease (ILD)/pneumonitis; severe dermatologic (skin) reactions (such as toxic epidermal necrolysis and acneiform dermatitis); ocular toxicity (eye damage); and harm to an unborn fetus.

In addition to the side effects listed above, the combination with chemotherapy may increase the risk of certain hematologic abnormalities (such as decreased white blood cells, hemoglobin, neutrophils, platelets, and lymphocytes).

When used in combination with lazertinib, there is an additional risk of venous thromboembolic events and hemorrhage.

For more information about this treatment, visit:

Rybrevant (Amivantamab-Vmjw) Injection, for Intravenous Use — U.S. Food and Drug Administration

Rybrevant — Drugs.com